Manual Registration Form

Please mail completed form to: <?xml:namespace prefix = o />

CMWC Registration

c/o La Carrera Cycles

106 Harbord Street

Toronto, ON, Canada

M5S-1G6

Please make out checks or money orders in US dollars to:
La Carrera Cycles

* Indicates required information.------------------------------

Select Events:

CMWC (check appropriate box based on post mark date):

before MAR 31 $80 ___ , before AUG 15 $100 ___ , before SEP 10 $120 ___

La Ocho, $100: _____   Bike Polo, $40: _____   Non-Racer, $60: _____

*First Name: __________________________________________                  

*Last Name: __________________________________________                                    

Nick Name: ___________________________________________

Team Name: ___________________________________________

*Gender:             Male     /           Female

*Date of Birth (mo/dy/yr):      _____/ ______  / _____

*Street Address:  _______________________________________                

*City:   _______________________________________________

State / Province: _______________________________________          

*Country:______________________________________________  

*Postal Code:___________                                                                                       
*E-mail Address: ________________________________________       

Phone Number: __________________________________________

Preferred Race Number (1 – 999):  __________________________

Alternate Race Number (1 – 999):  __________________________

Preferred Main Race Start Time:    8am   /   9am   /   10am   /   11am   /   12pm               

Alternate Main Race Start Time:     8am   /   9am   /   10am   /   11am   /   12pm               

Courier Experience (only working & ex-messengers are eligible to win CMWC events):None___ ,< than 1 year, ___ ,1-10 years___,> than 10 years___         

Emergency Contact Name:  _________________________________        

Emergency Contact, Email:   ________________________________       

Emergency Contact, Phone Number:__________________________

Primary Language:   _______________________________________

Secondary Language(s):____________________________________            

T-Shirt Size: _____               

Jersey Size:  _____                       

Shoe Size:    _____